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General NPI Number Information
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NPI Number | 1780063594
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Entity Type | Organization
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Legal Business Name | POUYAN, DDS AND KHANIDEH, DDS, INC.
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 2730 WILSHIRE BLVD SUITE 100
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City | SANTA MONICA
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State | CA
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Zip | 90403-4743
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Country | US
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Telephone | 310-828-2440
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Fax | 310-828-0177
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Provider Business Mailing Address
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Address Line | 2730 WILSHIRE BLVD SUITE 100
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City | SANTA MONICA
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State | CA
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Zip | 90403-4743
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Country | US
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Telephone | 310-828-2440
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Fax | 310-828-0177
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. SHABNAM KHANIDEH
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Credential | DMD
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Telephone | 310-828-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | CA
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